Ch. 16 Ears

Which information would the nurse share with a patient regarding a positive Rinne test? "There is a higher-than-normal chance you have a hearing problem." "This confirms your sensorineural hearing loss." "The sound lateralized to your 'poorer' ear, indicating conductive hearing loss." "You heard the sound twice as long by air conduction as by bone conduction."

A "positive" Rinne test indicates air conduction is heard twice as long as bone conduction. A "positive" Rinne test is a normal finding and does not indicate the patient has a higher chance of having a hearing problem. Be aware that neither test (Rinne or Weber) can distinguish normal hearing from a sensorineural hearing loss; audiometry is needed to confirm sensorineural loss. A Weber test indicates conductive hearing loss when the sound lateralizes to the "poorer" ear. A person with conductive hearing loss will hear the sound equally as long by bone as by air conduction or even longer by bone in a Rinne test.

Which assessment finding would the nurse observe in a patient who has a Darwin tubercle? Small, painless nodule at the helix Skin tag in front of the tragus Nodule behind the lobule Crusted, ulcerated sore on pinna

A Darwin tubercle is a small, painless nodule at the helix and is not a significant finding. A branchial remnant of leftover embryologic branchial arch usually appears as a skin tag occurring in front of the tragus. A sebaceous cyst is a nodule with central back punctum commonly located behind the lobule in the postauricular fold. A crusted, ulcerated nodule with an indurated base that fails to heal and is located on the superior rim of the pinna (the most sun-exposed area) is indicative of a carcinoma, not a Darwin tubercle.

Which findings would the nurse observe in a patient who has unreported hearing loss? Select all that apply. Answers questions slowly but appropriately Has a flat, monotonous tone of voice Speaks with an unusually loud voice Watches the nurse's face closely Strains forward to hear

All except: answers slowly but appropriately. pg.322

Which medication would the nurse suspect is causing a ringing sensation in the patient's ears? Acetaminophen Nitroglycerin Acetic acid Cisplatin

Cisplatin, an anticancer drug, causes tinnitus (ringing in the ears) and is ototoxic, leading to hearing loss in 60% to 65% of patients. Acetaminophen is used for fevers and mild pain and is not a drug that leads to tinnitus; however, chronic use of aspirin can lead to tinnitus. Nitroglycerin is a medication used to treat angina pectoris and does not lead to tinnitus. Acetic acid is used to prevent swimmer's ear and does not produce tinnitus.

vWhich cranial nerve would be damaged in a patient who has a hearing impairment? II VII VIII X

Cranial nerve VIII transmits the impulses of sound to the brain and aids in hearing. Damage to this cranial nerve can cause hearing impairment and result in deafness. The optic nerve is the second cranial nerve, which aids in vision. The facial nerve is the seventh cranial nerve, which controls facial expressions. The vagus is the tenth cranial nerve; it controls certain cardiovascular and gastrointestinal functions. Therefore damage to the second, seventh, or tenth cranial nerves will not result in hearing impairment.

Which information regarding cerumen would the nurse include in a teaching session? Poor hygiene affects the composition of cerumen. Flaky white cerumen occurs in Caucasians. Dry cerumen is generally found in East Asians. Ear infections cause the production of cerumen.

Dry cerumen is more frequent in East Asians and American Indians. The composition and presence of cerumen are not related to poor hygiene. Wet, honey-brown cerumen occurs in Caucasians and African Americans; flaky, white cerumen is found in East Asians and American Indians. Cerumen is normally produced as a lubricant, and it is not caused by ear infections.

Which inference would the nurse make after finding that the patient's ear canal is 70% blocked with cerumen? Hearing will be normal. There is a risk of developing osteoma. Whirling sensations will be present. This may cause disturbed equilibrium.

Even when the ear canal is 90% to 95% blocked with cerumen, hearing stays normal. Osteoma is a single, stony hard, rounded nodule that obscures the eardrum; it is not associated with cerumen. Inflammation of the labyrinth may cause impaired body balance, resulting in a whirling sensation and disturbed equilibrium in the patient. Because cerumen does not affect body balance, the patient would not have a whirring sensation and disturbed equilibrium.

Which assessment findings would the nurse observe in a patient who has frostbite of the ears? Select all that apply. Ear necrosis Vesicles Yellowish-amber tympanic membrane Reddish-blue discoloration of the auricle Painful, reddened hair follicles in the ear canal

Frostbite decreases the blood supply to the tissues and may result in ear necrosis, vesicles or bullae, and reddish-blue discoloration of the auricle. Frostbite is caused by exposure to extreme cold temperature, resulting in localized damage because of freezing. Accumulation of pus and serum in the middle ear can cause yellowish-amber discoloration of the tympanic membrane, which is a symptom of chronic otitis media or otitis media with effusion . The presence of painful, reddened, infected hair follicles in the ear canal indicates the patient has a furuncle, not frostbite.

Which technique should the nurse use when performing an otoscopic examination on an adult patient? Tilt the patient's head toward the nurse. Turn the otoscope upside down. Test the patient's hearing first. Remove traction once the otoscope is inserted.

Hold the otoscope "upside down" along with the nurse's fingers and have the dorsa (back) of the nurse's hand touching the patient's cheek to stabilize the otoscope. Tilt the patient's head slightly away from the nurse toward the opposite shoulder to bring the eardrum into better view. Perform the otoscopic examination before testing hearing; ear canals with impacted cerumen give the erroneous impression of pathologic hearing loss. Do not release traction on the ear until the nurse has finished the examination and the otoscope is removed.

Which priority action should the nurse take for a patient who was in an accident and has clear, watery drainage from the ear? Instill 2% acetic acid solution in the patient's ear. Administer antibiotic solution into the patient's ear. Report to the health care provider about the patient. Clean the patient's ear canal with a dry 4-×-4 sterile pad.

If a patient has a clear, watery drainage from the ear, it indicates that the patient has cerebrospinal fluid drainage because of a basal skull fracture, which requires immediate treatment to prevent further damage. Therefore the nurse would report this finding to the health care provider immediately. Instilling 2% of acetic acid solution is for swimmer's ear; it does not help prevent cerebrospinal fluid drainage. Antibiotic solutions help prevent ear infections, but it is not the priority action for cerebrospinal fluid drainage. Cleaning the ear canal with a dry sterile 4-×-4 may be indicated, but it is not the priority action for cerebrospinal fluid leakage.

Which structure of the ear would be dysfunctional in a patient who reports spinning and whirling sensations? Labyrinth Ear ossicles Eustachian tube External auditory canal

If the labyrinth is dysfunctional, spinning and twirling (whirling) sensations occur in a patient. The labyrinth is a part of the inner ear, consisting of the organs that aid in hearing and maintaining body balance. Ear ossicles help in the conduction of sound vibrations to the inner ear and protect the inner ear from loud sounds. Damage to ear ossicles may result in loss of hearing. The eustachian tube helps in equalization of air pressure on both sides of the tympanic membrane. If the eustachian tube is damaged, it results in muffled sounds, earache, and a feeling of fullness in the ears. The external auditory canal consists of wax glands, which secrete wax that acts as a barrier and prevents the invasion of foreign bodies into the ear.

Which action should the nurse take for an ear canal filled with cerumen in a patient who reported ear pain that stopped after a popping sensation? Avoid irrigating the patient's ear. Instill rubbing alcohol into the patient's ear. Irrigate the patient's ear canal with warm water. Clean the patient's ear with a cotton bud dipped in mineral oil.

If the patient has symptoms of a perforated tympanic membrane, the nurse would avoid irrigating the patient's ear canal, which could worsen the patient's symptoms. Symptoms of perforation include ear pain occurring first then stopping with a popping sensation, followed by drainage. The nurse would not want to instill rubbing alcohol into a ruptured eardrum. Irrigating the patient's ear canal with warm water can cause further damage after a perforation. Cleaning the patient's ear with a cotton bud may push the ear discharge and cerumen deeper into the ear.

Which documentation would indicate that the nurse's observations about the light reflex seen during an otoscopic examination were normal? Is at the 4 o'clock position in the left ear Is absent in both ears Is amber yellow in color Is at the 5 o'clock position on the right

In the right drum, the light reflex is at the 5 o'clock position. The cone-shaped light reflex is prominent in the anteroinferior quadrant of the ear and is a reflection of the otoscope light. In the left eardrum it is in the 7 o'clock position, not the 4 o'clock position. Absence of the cone of light can be a sign of increased inner ear pressure or otitis media and is not a normal finding. An amber yellow color is abnormal and is seen in cases of middle ear infection with effusion or in chronic ear infections; the light reflex is whitish in color.

A patient with cellulitis presents with a thick, inflamed auricle. Which additional external ear abnormality would the nurse monitor for? Whitish-yellow nodules Scar tissue Induration Scaling

Induration of the auricle occurs with cellulitis. Cellulitis is caused by inflammation of subcutaneous connective tissue and is characterized by the presence of a thick auricle and distorted ears. Whitish-yellow nodules, scar tissue, and scaling are not associated with cellulitis. Tophi are associated with the presence of small, whitish-yellow, hard nodules present in the helix or antihelix regions of the ear and are characterized by the deposition of uric acid crystals. A keloid is the overgrowth of scar tissue, which is more commonly found in the lobule. Otitis externa is an external ear infection, characterized by presence of redness and swelling in the pinna and scaling.

Which term would the nurse use to report a patient's ear pain from a tooth problem? Otalgia Osteoma Otorrhea Ototoxic

Otalgia is characterized by ear pain and can be caused by an ear, dental, or oropharynx disorder. A patient who is scheduled for root canal surgery may also report having ear pain, which indicates it is a referred pain, so the nurse would conclude that the patient has otalgia. Osteoma is characterized by the presence of a stony hard and rounded nodule that obscures the ear drum. Otorrhea is ear discharge associated with an infected canal or perforated eardrum. "Ototoxic" refers to anything harmful to the ear, such as certain medications.

Which landmarks would the nurse observe when examining the tympanic membrane of a patient? Select all that apply. Umbo Manubrium Vestibule Stapes Short process of the malleus

Sections of the malleus are visible through the translucent drum: the umbo manubrium, and short process. The nurse would systematically explore these landmarks of the tympanic membrane during the examination. The vestibule is not a landmark of the tympanic membrane. It is a part of the inner ear, found within the bony labyrinth. Although the stapes is an auditory ossicle, it cannot be observed as the malleus can.

Which condition would the nurse monitor for in a patient who is taking an aminoglycoside antibiotic? Acute otitis media Conductive hearing loss Sensorineural hearing loss Chondrodermatitis nodularis helicus

Sensorineural hearing loss is caused by gradual degeneration of the nerves with aging or because of ototoxic drugs such as aminoglycoside antibiotics. This medication may affect the hair cells in the cochlea, resulting in sensorineural hearing loss. Aminoglycoside antibiotics are used to treat bacterial infection, but they do not cause middle ear infections such as acute otitis media. Conductive hearing loss is caused by external and middle ear disorders; aminoglycosides affect the inner ear, causing sensorineural hearing loss. Chondrodermatitis nodularis helicus is caused by repetitive mechanical pressure or environmental trauma, but not by aminoglycosides.

Which signs and symptoms would the nurse find in the patient with cholesteatoma? Select all that apply. Tinnitus Otorrhea Inflammation of the pinna Blue discoloration of the eardrum Pearly white-colored tympanic membrane

Signs and symptoms of cholesteatoma include tinnitus, otorrhea, and pearly white-colored tympanic membrane. Cholesteatoma is an overgrowth of the epidermal tissue in the middle ear. Early signs include tinnitus, otorrhea, and unilateral conductive hearing loss. The patient may also have a cheesy and pearly white tympanic membrane. Inflammation of the pinna is caused by cellulitis, not cholesteatoma. A blue eardrum, hemotympanum, occurs from trauma (not cholesteatoma) resulting in a skull fracture and indicates blood in the middle ear.

Which otoscopic finding would the nurse observe for a patient with mycoplasma pneumonia infection who has bullous myringitis? Many white dots One large polyp Small blood-filled vesicles Cheesy, pearly white drum

Small blood-filled vesicles

Subjective Vertigo Vs. Objective Vertigo

Subjective: : I feel like I'm spinning" Objective: I feel like the room is spinning

Which outcomes would the nurse expect in a patient after insertion of tympanostomy tubes? Select all that apply. Increased blood supply to the middle ear Improved aeration in the middle ear Increased outflow of fluid from the middle ear Reduced risk of recurrent middle ear infection Increased pressure in the middle ear

Surgical insertion of tympanostomy tubes helps improve aeration in the middle ear, drains the accumulated fluid from the ear, which results in increased outflow of fluid from the middle ear, and reduces risk of recurrent middle ear infection. The tympanostomy tube helps drain the fluid but does not enhance the circulation of the blood, so the patient would not have increased blood supply to the middle ear. The accumulated fluid in the middle ear increases pressure in the ear, so tympanostomy tubes are designed to decrease the pressure in the middle ear.

Which parameters would the nurse assess in an older adult patient by performing the Romberg test? Select all that apply. Standing balance Air conduction Bone conduction Proprioception Intactness of the cerebellum

The Romberg test determines standing balance, proprioception and intactness of the cerebellum. The Romberg test assesses the functional ability of the vestibular apparatus in the inner ear, which helps maintain standing balance. The Romberg test can also assess proprioception, which is the ability to sense the stimuli that arise within the body, such as position and motion and intactness of the cerebellum. Unlike the tuning fork test, the Romberg test does not measure the ability of hearing by determining air and bone conduction.

Which test would the nurse perform for a patient who reports having impaired balance? Rinne Weber Romberg Otoacoustic emission

The Romberg test helps assess the ability of the vestibular apparatus in maintaining standing balance. The vestibular apparatus present in the inner ear is responsible for maintaining body balance. Rinne, Weber, and OAE tests are used to evaluate hearing impairment, not impaired balance. Rinne and Weber tests are the tuning fork tests that are used to measure hearing loss. In tuning fork tests, the hearing is measured by bone and/or air conduction. The otoacoustic emissions (OAE) test is used to screen hearing ability in the newborn.

Which part of the ear connects the middle ear to the nasopharynx? Eustachian tube Semicircular canals Tympanic membrane External auditory canal

The eustachian tube connects the middle ear to the back of the nose and the upper part of the throat (nasopharynx). The semicircular canals are the three tubes present in the inner ear; they do not connect the middle ear to the nasopharynx. The tympanic membrane is also called the eardrum, separating the external and the middle ear. The external auditory canal is a long tube that leads to the tympanic membrane.

Which process is a function of the eustachian tube? Lubricating the ear Acting as a barrier against foreign bodies Maintaining equilibrium of the body Equalizing air pressure on both the sides of the eardrum

The eustachian tube is part of the middle ear, and it equalizes air pressure on both sides of the eardrum. The external auditory canal is part of the external ear and consists of wax glands that secrete cerumen to promote the lubrication of the ear. Cerumen acts as a sticky barrier that traps foreign bodies and prevents them from reaching the tympanic membrane. The inner ear contains the bony labyrinth, which comprises the parts that aid in hearing and maintaining body balance (equilibrium).

Which group of individuals has a higher risk of acute otitis media? Infants Adolescents Adults Geriatrics

The eustachian tube of the infant is shorter, wider, and straighter than in other age groups. This enables microorganisms to enter the middle ear through the nasopharynx more easily, which means that infants are more prone to middle ear infections than other age groups. Acute otitis media is so common that up to 60% of children experience an episode during the first year of life, and by age 3 years up to 83% have suffered an episode. In adolescents, adults, and geriatric patients, the eustachian tube is long, narrow, and slightly curved so that microorganisms may not pass as easily into the middle ear and cause infection.

Which bones would be located in the middle ear? Select all that apply. Labyrinth Incus Malleus Stapes Mastoid

The middle ear contains three ear bones, or auditory ossicles: incus, malleus, and stapes. The bony labyrinth is in the inner ear and holds the sensory organs for equilibrium and hearing. The mastoid process, the bony prominence behind the lobule, is not part of the ear but is an important landmark.

Which examples are functions of the middle ear? Select all that apply. Equalizes air pressure Protects the inner ear Conducts the sound vibrations Maintains a sense of equilibrium Transmits sound waves to the brain

The middle ear has three functions: equalizes air pressure, protects the inner ear, and conducts the sound vibrations. It equalizes air pressure with the help of the eustachian tube. It protects the inner ear by reducing the amplitude of loud sounds. It conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear. Equilibrium is the function of the inner ear, not the middle ear. Transmitting sound waves to the brain is a function of the inner ear, not the middle ear.

Which question would the nurse ask the patient who has labyrinth dysfunction? "Do you have any discharge from the ears?" "Have you ever had any difficulty while traveling by air?" "Have low-set ears been common in your family?" "Do you ever feel as if the room is spinning around you?"

The nurse would ask the patient whether he or she feels as if the room is spinning, which is a sign of vertigo. Labyrinth dysfunction may impair body balance and result in vertigo. The nurse would ask about ear discharge if the patient had a middle ear infection, such as acute or chronic otitis media. The eustachian tube allows equalization of air pressure on both sides of the eardrum, so the nurse would ask the patient about difficulties in traveling by air if the patient had an eustachian tube disorder. The nurse would not inquire about low-set ears because this is associated with Down syndrome, not labyrinth dysfunction.

Which action should the nurse take during an otoscopic examination of an adult patient? Hold the pinna firmly. Pull the auricle downward. Touch the speculum to the bony surface. Choose the smallest speculum.

The nurse would hold the pinna gently but firmly. In case of an infant or a child younger than 3 years of age, the nurse would pull the auricle downward. The nurse would insert the speculum slowly and carefully along the axis of the canal. The nurse would avoid touching the inner "bony" section of the canal wall. It is covered by a thin epithelial layer and is sensitive to pain. Choose the largest (not smallest) speculum that fits comfortably in the ear canal and attach it to the otoscope.

Which actions would the nurse take to soften the cerumen and irrigate a patient's ear canal? Select all that apply. Instill warmed solution of mineral oil and hydrogen peroxide into ear canal. Obtain a low-pulsatile Water-Pik. Attach a pneumatic bulb to the otoscope. Direct the fluid to the anterior wall. Ensure that the irrigator tip on the bulb syringe completely fills the ear canal.

The nurse would instill a warmed solution of mineral oil and hydrogen peroxide into the ear canal to soften the cerumen and would obtain a low-pulsatile Water-Pik to irrigate the ear canal with warm water. A pneumatic bulb is used for pediatric patients to determine vibratility of the tympanic membrane and is not used to irrigate the ear canal or soften cerumen. The fluid is directed to the posterior wall, not the anterior wall. The nurse would leave space around the irrigator tip for water to escape; if it completely fills the ear canal, water cannot drain or expel the impacted cerumen.

Which intervention would be beneficial for the older adult patient diagnosed with presbycusis? Suggest the use of hearing aids to the patient. Instill antibiotic solutions into the patient's ear. Insert tympanostomy tubes into the patient's ear. Irrigate the patient's ear canal with a warm solution.

The nurse would suggest hearing aids to improve hearing in the older adult patient with presbycusis. Presbycusis is an age-related hearing loss caused by degeneration of the auditory nerve in the inner ear, which consequently results in sensorineural hearing loss. Antibiotics help alleviate the symptoms of an ear infection, but do not prevent degeneration of the nerve. Tympanostomy tubes facilitate the outflow of fluid accumulated in the middle ear but do not help prevent nerve degeneration. Irrigating the ear canal with a warm solution helps flush out the impacted cerumen in the middle ear and prevents conductive hearing loss, but this intervention does not help prevent degeneration of the nerve caused by aging.

Which term would the nurse use to describe a patient's ears that are 3 centimeters (cm) in length? Pars flaccida Pars tensa Microtia Macrotia

The nurse would use the term microtia. When a patient has smaller ears, the length of which is less than 4 cm vertically, it indicates that the patient has microtia. Pars flaccida is the small, slack superior section of the tympanic membrane; the pars tensa is the thicker, tauter part of the tympanic membrane. If the patient's ears are more than 10 cm in length, then it indicates that the patient has macrotia. Because the patient's ears are not more than 10 cm long, the nurse concludes that the patient does not have macrotia.

Which finding would the nurse observe in a patient with a basal skull fracture? Redness in the ear with purulent discharge Dirty yellow-colored, foul odor discharge from the ear Frank blood and watery discharge from the ear Reddish-blue discoloration from the ear with necrosis

The patient with a basal skull fracture may have frank blood and watery discharge or cerebrospinal fluid (CSF) discharges from the ear. An injury to the skull may damage the meninges and blood vessels of the brain, which can result in leakage of CSF and active hemorrhage. The presence of redness in the ear with purulent discharge indicates the patient has otitis externa. The presence of dirty yellow-colored, foul discharge from the ear indicates the patient has cholesteatoma, which is caused by continuous growth of tissue in the middle ear. The reddish-blue discoloration of the ear with necrosis indicates that the patient has frostbite, not a basal skull fracture.

Which color of the tympanic membrane would the nurse observe during an otoscopic examination of a patient with chronic otitis media? Blue Bright red Pearly gray Yellow-amber

The patient with chronic otitis media may have an accumulation of serum in the middle ear, which causes the tympanic membrane to appear yellow-amber in color. Trauma or skull fracture may cause bleeding and accumulation of blood in the ear, which gives a blue or dark red appearance to the tympanic membrane. Acute otitis media is associated with inflammation and vasodilation of the middle ear, which makes the tympanic membrane appear bright red in color. The presence of a pearly gray tympanic membrane is a normal finding, so the nurse would not associate this finding with chronic otitis media.

Which history finding would be typical for the patient who has presbycusis? Is an older adult Swims daily Has an obstructed eustachian tube Was bottle-fed during the first three months of age

The patient with presbycusis is an older adult. Presbycusis is the age-related progressive sensorineural loss because of nerve degradation in the inner ear. Presbycusis is not associated with swimming, obstruction of the eustachian tube, or bottle-feeding. Logging of water in the ear results in swimmer's ear, or otitis externa, as a result of the presence of excessive moisture in the ear. Otitis media can be caused by an obstruction in the eustachian tube. Neonates who are not breastfed (who are bottle-fed) for the first three months of age have a higher risk of developing otitis media, but not presbycusis.

The patient has labyrinthitis and presents with vertigo. Which additional finding would the nurse monitor for? A staggering gait Cerumen impaction Watery discharge from the ear Conductive hearing loss

The presence of a staggering gait, loss of balance, and spinning or whirling sensations may indicate that the patient has labyrinthitis. Labyrinthitis is associated with inflammation of the labyrinth and may impair body balance and cause vertigo. Unlike the external ear, the labyrinth does not have wax glands that produce cerumen, so labyrinthitis does not lead to an accumulation of earwax in the ear canal that causes cerumen impaction. The presence of watery discharge from the ear indicates that the patient has external otitis or cerebrospinal fluid drainage, neither of which is associated with labyrinthitis.

Which otoscopic finding would the nurse observe in a patient who has an ear infection with effusion? Pearly gray-colored eardrum Whiter and denser annulus at the periphery Yellow/amber-colored tympanic membrane Visible malleus behind the tympanic membrane

The presence of a yellow/amber-colored tympanic membrane indicates otitis media with effusion, which is a middle ear infection. The normal tympanic membrane is shiny, translucent, and pearly gray in color. Usually, the annulus appears white in color and denser at the periphery. Therefore it does not indicate that the patient has an infection. In a healthy individual, the malleus is visible through the tympanic membrane.

Which term would the nurse use in report for a patient with gout who has small, whitish-yellow nodules and uric acid crystals in the ear helix? Tophi Keloid Osteoma Exostosis

The presence of small, hard whitish-yellow nodules in the helix indicates the patient with gout has tophi. These lumps are caused by the deposition of uric acid crystals, which is common in patients with uric acid gout. A keloid is an outgrowth of scar tissue around a wound; in the ear, keloids develop mostly at the ear lobule. Osteoma is a single, stony hard, rounded benign nodule that obscures the eardrum and is not caused by gout. Exostosis is a small, bony hard, rounded nodule of hypertrophic bone; it is not associated with gout.

In which area would the nurse place the tuning fork to perform the Weber test on a patient? Behind the patient's ear On top of the patient's head By the patient's ear canal Directly on the tragus

The tuning fork is placed on top of the patient's head when performing the Weber test. The Rinne test places the tuning fork behind the patient's ear and by the patient's ear canal. A tuning fork is not placed directly on the tragus for the Weber test.

How would the normal tympanic membrane appear during an otoscopic examination? Straight and pink Convex and slightly white Opaque and red Concave and pearly gray

The tympanic membrane is concave with a pearly gray color. The tympanic membrane is oval, pulled in at its center and is not straight. The tympanic membrane is not convex or opaque; it is concave and translucent. The normal tympanic membrane is pearly gray, and is not pink, slightly white, or red in color.

Which part of the ear does the tympanic membrane separate? The external and the middle ear The middle and the inner ear The auricle and the cochlea The middle ear and the eustachian tube

The tympanic membrane separates the external ear and the middle ear. The tympanic membrane does not separate the middle and the inner ear; the middle and the inner ear are connected by the stapes in the oval window. The auricle is the outer ear, and the cochlea is in the inner ear, so those two structures are separated by the middle ear, not the tympanic membrane. The eustachian tube is part of the middle ear, so there is no separation between these structures.

Which action would the nurse take to administer the whisper voice test to a patient? Whisper "M, C, W" Stand in front of the patient Stand 2 feet behind the patient Whisper "4, 2, 5"

To perform the whisper voice test, the nurse would stand 2 feet behind the patient. The nurse would whisper a set of three random numbers and letters, such as "5, B, 6." Then the nurse asks the patient to repeat the numbers and letters. This helps the nurse assess the hearing ability of the patient. The nurse would not whisper just letters ("M, C, W"). If the nurse stands in front of the patient and whispers the numbers, the patient may be able to understand them by lipreading. The nurse might thus make an inaccurate assessment that the patient has normal hearing. The nurse will not whisper "4, 2, 5" but will whisper 3 random numbers and letters, such as "4, K, 2."

Which assessment finding would be typical in a patient with otitis externa? Reddish-blue swollen auricle Dirty gray discharge with foul odor Tragus pain upon palpation Branchial remnant

Tragus pain upon palpation is typical in otitis externa, also called swimmer's ear. Frostbite is marked by reddish-blue discoloration and swelling of the auricle; this does not occur in otitis externa. Dirty gray discharge with a foul odor is typical of cholesteatoma, not otitis externa. The branchial remnant is the leftover embryologic branchial arch, occurring most often in the preauricular area, in front of the tragus.

Which otoscopic finding would the nurse observe in a patient who has a perforated tympanic membrane? Bright red drum Dark oval area White dense area Black dots on drum

Usually the perforation appears as a round or oval darkened area on the drum. A bright red drum indicates acute otitis media, not a perforated eardrum. A white dense area indicates scarring, not perforation. Black dots on the drum or canal indicate fungal infection, not a perforated tympanic membrane.

Which assessment finding would be consistent with a diagnosis of vertigo? Feels pain when the auricle is pulled Has dry cerumen in the auditory canal Reports a persistent ringing in the ears Describes a sensation of the room revolving

Vertigo is a true twirling motion (revolving) and occurs with dysfunction of the labyrinth. The patient feels pain when the pinna is pulled in cases of otitis externa, not with vertigo. Dry cerumen in the auditory canal affects hearing, and the patient may have conductive hearing loss, not vertigo. Ringing in the ear is termed tinnitus, a "phantom sound" that occurs with cerumen impaction or middle ear infection or other ear disorders.

Which finding would be consistent with wet cerumen in a patient's ear? Flaky Whitish Honey-brownish Desiccated

Wet cerumen is moist and will be honey-brown in color. The characteristic features of cerumen vary from one individual to the other, and cerumen is classified as dry or wet. Dry cerumen is desiccated, flaky, and white in color.

Which technique should the nurse use to straighten the adult patient's ear canal during an otoscopic examination? Pull the pinna straight out. Pull the pinna up and back. Pull the auricle down and back. Pull the auricle straight down.

While performing the otoscopic examination in an adult patient, the nurse would pull the patient's ear up and back, which helps straighten the S-shaped ear canal. Pulling the ear straight out could hinder the examination. Pulling the patient's auricle down and back or straight down is effective only on children under the age of 3 to match the slope of the ear canal.